Análisis de cuatro años de funcionamiento de un programa de donante a corazón parado extrahospitalario / Prehospital non-heart-beating donors: 4 years’ experience of the SUMMA112 emergency service

Objetivo: El Servicio de Urgencias Médicas de Madrid SUMMA112 está integrado en un programa de donación de órganos de pacientes con una parada cardiorrespiratoria (PCR) extrahospitalaria que no responden a las maniobras de reanimación cardiopulmonar(RCP) avanzada. El objetivo de este estudio es conocer el cumplimiento de los tiempos del programa, la proporción de donantes, las características de los donantes y no donantes y el número de órganos obtenidos. Métodos: Estudio descriptivo retrospectivo de los donantes y órganos obtenidos durante 4 años (2005-2009) que se basa en la revisión de las historias clínicas. Se recogen los siguientes datos: edad, sexo, tiempo de llegada a la asistencia, tiempo de llegada al hospital, número total de órganos donados, tipo de órgano donado y la no donación si ésta existiera. Resultados: Se recogieron un total de 132 casos, 85% varones. La edad media fue de 40 años. El tiempo medio de llegada a la escena fue de 14 minutos y 52 segundos y al hospital fue de 91 minutos. Se consiguieron 356 órganos procedentes de 96 donantes válidos (158 riñones, 16 hígados, 97 córneas, 72 tejidos óseos y 13 pulmones; 3,7 órganos por paciente). El 27,3% de los pacientes fueron no válidos. No hay diferencia entre los donantes válidos y no válidos en la edad y el sexo. Las causas para la no donación fueron el fallo en la circulación extracorpórea (8,3%), la negativa familiar (13,9%) o del propio paciente en vida (2,8%), la causa biológica (44,4%) y otros (30,6%). Conclusión: Un programa de estas características consigue un número de órganos para trasplante muy importante que ayuda a disminuir las listas de espera (AU)

Background and objective: The emergency medical service of Madrid (SUMMA112) participates in a program to facilitate organ donation from patients in cardiorespiratory arrest who do not respond to advanced cardiopulmonary resuscitation maneuvers before arriving at the hospital. Patients who meet the criteria for inclusion are transferred to a transplant unit for extraction of organs while resuscitation maneuvers continue. The aim of this study was to determine time intervals under the program, the percentage of donors, the characteristics of donors and non donors, and the number of organs obtained. Material and methods: Descriptive, retrospective study of donors and organs obtained through the participation of SUMMA112 in the donation program over a 4-year period (2005-2009), based on review of medical records. The following data were extracted: age, sex, time until arrival of the ambulance, time until arrival at the hospital, number of organs donated, and type of organ donated. We also recorded the reason for not donating: patient refusal, family refusal, pump failure, biologically nonviable state, and other. Results: A total of 132 cases (85% male) were found. The mean age of patients was 40 years. The mean time until arrival of emergency caregivers at the scene was 14 minutes, 55 seconds. The mean time until arrival at the hospital was 92 minutes. Three hundred fifty-six organs (158 kidneys, 16 livers, 97 corneas, 72 bone tissues, and 13 lungs) were obtained, corresponding to 2.3 organs per patient; 27.3% of the patients were nonviable donors. There were no age or sex differences between viable and nonviable donors. Reasons for not donating were failure of extracorporeal circulation (8.3%), refusal of(..) (AU)

Diversity of Colombian strains of Bacillus thuringiensis with insecticidal activity against dipteran and lepidopteran insects.

AIM: To evaluate the genetic and molecular diversity and insecticidal activity of Bacillus thuringiensis isolates from all the natural regions of Colombia. METHODS AND RESULTS: A total of 445 isolates from a collection of B. thuringiensis were characterized. The parasporal crystal morphology that was most abundant was bipyramidal (60%). Almost 10% of the isolates were toxic to Spodoptera frugiperda and 5.6% against Culex quinquefasciatus larvae. cry gene content determined by PCR indicated that 10.6% of the isolates contained cry1 genes and 1.1% contained cry2, cry4 or cry11 genes. Protein content of the parasporal crystal was determined by SDS-PAGE; 25 and 18 different protein profiles were found in isolates active against S. frugiperda and C. quinquefasciatus, respectively. CONCLUSIONS: Bacillus thuringiensis presents great genetic and molecular diversity even in isolates from the same soil sample. Moreover, the diversity and activity of the isolates might have a relationship with the geographical origin of the samples. SIGNIFICANCE AND IMPACT OF THE STUDY: The results obtained here indicate that some of the B. thuringiensis isolates characterized in this study are potential control agents that could be used in programmes against mosquitoes and S. frugiperda.

Chest pain: overlooked manifestation of unsuspected esophageal foreign body.

Two cases of unsuspected esophageal foreign body ingestion with chest pain as the main symptom are reported. Both patients had extensive cardiac evaluation to rule out myocardial ischemia. They were discharged home with continuing chest pain and odynophagia. Both patients were denture wearers, and further questioning revealed the coincidence of chest pain with taking meals. Further evaluation revealed an impacted esophageal foreign body in one patient and an esophageal perforation with a mediastinal abscess in the other. These cases illustrate the importance of considering esophageal foreign bodies as factors in chest pain.

Esophageal cast: a manifestation of graft-versus-host disease.

Diffuse involvement of the gastrointestinal tract by graft-versus-host disease (GVHD) is a common complication of bone marrow transplantation. The esophageal involvement in this disease tends to be a vesiculobullous, ulcerative or desquamative process. To our knowledge, esophageal cast has not been described in the context of GVHD. However, it has been described as a result of trauma to the esophagus or in association with bullous disease of the skin. We present a case of esophageal cast in a patient with chronic GVHD following bone marrow transplant.

Incidence of pancreatitis in patients undergoing sphincter of Oddi manometry (SOM).

OBJECTIVE: Sphincter of Oddi manometry (SOM) is a useful diagnostic procedure when evaluating patients with unexplained biliary pain or idiopathic recurrent pancreatitis. Acute pancreatitis is a recognized complication of SOM whose pathogenesis appears to be multifactoral. We conducted this study to determine the incidence of pancreatitis in patients after SOM and to identify any variables that may lead to an increased incidence of pancreatitis. METHODS: A retrospective review of 100 consecutive patients who underwent SOM between 1992 and 1996 at two university-affiliated hospitals was done. SOM was performed using a triple lumen catheter with each lumen perfused at a rate of 0.25 cc/min using an Arndorfer pneumohydraulic capillary perfusion system. The following data were recorded: age, gender, clinical type of sphincter of Oddi dysfunction, length of procedure, doses of medications used, duct cannulated, sphincter of Oddi pressure, whether endoscopic retrograde cholangiopancreatography (ERCP) with or without sphincterotomy was performed, and the number of patients developing pancreatitis. Statistical analysis was performed using a T test, chi2, and multiple regression analysis. RESULTS: The overall incidence of pancreatitis was 17%. Six patients with type II SO dysfunction and 11 patients with type III SO dysfunction developed pancreatitis. The incidence of pancreatitis was significantly lower in those patients who only had SOM, compared with those patients who had SOM and ERCP (9.3% vs 26.1%, p < 0.026). There was no significant correlation between age, gender, duration of procedure, dose of midazolam used, sphincter of Oddi pressure, or type of SO dysfunction with the development of SOM-induced pancreatitis. Multiple regression analysis showed that sphincterotomy added no additional risk, beyond that associated with ERCP, for the development of pancreatitis. CONCLUSIONS: The results of this study indicate that the incidence of pancreatitis was highest when SOM was followed by ERCP. A potential method of decreasing the incidence of pancreatitis after SOM is performing ERCP with or without sphincterotomy at another session, separated from the SOM by at least 24 h. Before this can be definitely recommended, the results of this study must be validated by others or by a prospective study.

Pseudolymphoma of the breast: case report and literature review.

Pseudolymphomas of the breast are extremely rare: the etiology of these lesions is unclear, but some believe they may represent a response to local injury. Although morphologically similar to malignant lymphomas, they are benign. Here we report a case of pseudolymphoma of the breast and present a review of the literature.

Identification of the new 18-hexacosenoic acid in the sponge Thalysias juniperina.

The phospholipid fatty acids from the sponge Spheciospongia cuspidifera were studied revealing the presence of the rare 10-octadecenoic acid (10-18:1) and a new 2-methoxyhexadecenoic acid. The phospholipid fatty acids from Thalysias juniperina were also studied revealing the presence of the hitherto unreported 18-hexacosenoic acid (18-26:1). These results tend to indicate that the biosynthetic pathway from 10-18:1 to 18-26:1 may be operative in nature. The phospholipid mixture from the sponges was also analyzed by 31P-NMR and shown to mainly consist of phosphatidylethanolamine, phosphatidylserine, phosphatidylinositol, and phosphatidylglycerol. Phosphatidylcholine was not found in the sponges analyzed in this work.

On the isolation of the new fatty acid 6,11-eicosadienoic (20:2) and related 6,11-dienoic acids from the sponge Euryspongia rosea.

The phospholipid fatty acids from the sponge Euryspongia rosea were studied revealing the presence of the new 6,11-eicosadienoic (20:2) acid and the rare 6,11-octadecadienoic acid (18:2). The isolation of these 6,11-dienoic acids reveals the presence of new biosynthetic possibilities in sponges and suggests the presence of an active delta 6 desaturase in E. rosea. Other acids isolated from E. rosea include 12-eicosenoic (20:1) and 17-tetracosenoic acid (24:1). The major phospholipids encountered in the sponge were phosphatidylethanolamine (PE), phosphatidylserine (PS), and phosphatidylcholine (PC).

New phospholipid fatty acids from the Caribbean sponge Ectyoplasia ferox.

The phospholipid fatty acids from the Caribbean sponge Ectyoplasia ferox were studied. The novel fatty acids 25-methyl-5,9-heptacosadienoic (1) and 26-methyl-5,9-heptacosadienoic (2) were identified in 3.4 and 2.0% abundance, respectively, representing the longest set of delta 5,9 iso and anteiso acids yet isolated from a marine sponge. The new acid 10,13-dimethyltetradecanoic (3), the unusual acid 15-methyl-11-hexadecenoic (4) and the also novel acid 9-methyl-11-hexadecenoic (5) were also identified in E. ferox. The principal sterols isolated from E. ferox were 24-ethylcholest-5-en-3 beta-ol (46%) and 24(R)-methylcholesta-5,22-dien-3 beta-ol (14%).

6-methyl-8-hexadecenoic acid: A novel fatty acid from the marine spongeDesmapsama anchorata.

The novel fatty acid 7-methyl-8-hexadecenoic (1) was identified in the marine spongeDesmapsama anchorata. Other interesting fatty acids identified were 14-methyl-8-hexadecenoic (2), better known through its methyl ester as one of the components of the sex attractant of the female dermestid beetle, and the saturated fatty acid 3-methylheptadecanoic (3), known to possess larvicidal activity. The main phospholipid fatty acids encountered inD. anchorata were palmitic (16∶0), behenic (22∶0) and 5,9-hexacosadienoic acid (26∶2), which together accounted for 50% of the total phospholipid fatty acid mixture.

Venom from two sub-species of Heloderma horridum (Mexican beaded lizard): general characterization and purification of N-benzoyl-L-arginine ethyl ester hydrolase.

The venom from the lizards Heloderma horridum horridum and Heloderma horridum alvarezi was obtained at a protein concentration of 80 mg/ml with a pH value of 6.9-7.0. The volume of venom obtained is approximately 0.5 ml per extraction. The i.p. LD50 value in mice for both sub-species is 2 mg/kg body weight. The electrophoretic pattern of the venom applied to polyacrylamide gels shows at least 18 protein bands and this pattern is constant for the same animal during all 12 months of the year, although different animals from the same population may present a slightly different pattern. The venom has the following enzymatic activities: phospholipase A, hyaluronidase, and Bz-Arg-OEt and Bz-Tyr-OEt hydrolase. Some of the venom components can be selectively and reversibly precipitated at acidic pH (4.7). The venom is very immunogenic and the sheep anti-sera against both sub-species cross-react quite extensively. A Bz-Arg-OEt hydrolase was purified from the venom of H. h. horridum by column chromatography in Sephadex G-75 followed by two steps on DEAE-cellulose columns at two different pH values (7.55 and 8.6). The last step was chromatography in a phenyl-sepharose column. The molecular weight of this enzyme, as obtained by SDS-gel electrophoresis, is approx. 65,000.